Objective To evaluate the surgical treatment and its results of complex tibial plateau fractures.Methods From May 2003 to November 2004, 24 cases of complex tibial plateau fractures were treated by two-incision approaches. There were 16 males(including 1 case of bilateral), and8 females, with mean age of 40.6 years(21-65 years), eleven fractures occurred in left extremity and 14 in the right. No patients suffered open fractures. Fracture was caused by fall from height in 10 cases, by traffic accident in 12 cases and by another causes in 2 cases. According to Schatzkerclassification, type Ⅴ fracture was found in 14 extremities，type Ⅵ in 11 extremities. All cases were operated with twoincision approaches and double-plates fixation. The operation was performed 6-15 days after injury with mean 10.4 days. Results All cases were followed up from 12 to 23 months (mean 15.6 months). Time of the bone healing was 69 months, with mean 7.4 months. No reduction of anatomy was achieved because of comminuted fractures of articular surfaces in 2 limbs. The line of the lower extremity did not recover because of metaphysis comminution in 1 limb, which led to knee varus. Epidermal necrolysis was observed in 3 limbs, and the wound healedafter change dressing. The function of the knee wasevaluated according to Rasmussen’s criteria, the results were excellent in 10limbs, good in 8 limbs, fair in 3 limbs, and poor in 4 limbs. Conclusion The twoincision approaches reduced the complication of softtissueinjury, which is conductive to reduction of articular surface. Double-plates provide a sufficient internal fixation. It can permit early motion of knee joint. Therefore, two-incision approach are an effective surgical approach of treatment of complex tibial plateau fractures.
【摘要】 目的 比較脛骨平臺骨折術后輔助與不輔助持續被動運動（continuous passive motion，CPM）的臨床療效。 方法 對2008年6月-2009年6月86例行手術治療的閉合性、無合并損傷的脛骨平臺骨折患者進行回顧性分析。根據是否輔助CPM分為CPM組27例和非CPM組（對照組）59例。對兩組患者的傷口愈合情況，膝關節屈曲、伸直角度，以及膝關節功能恢復情況進行比較。 結果 兩組傷口甲級愈合率差異無統計學意義（P=0.566）。在術后2周和6周，CPM組患者的膝關節屈曲角度明顯大于對照組（Plt;0.001），但在術后3個月和12個月，兩組的差異無統計學意義（P=0.219，P=0.512）。在術后2、6周，3、12個月，CPM組和對照組患者的膝關節伸直角度差異無統計學意義。在術后12個月的Rasmussen膝關節功能評分方面，CPM組和對照組的差異無統計學意義。 結論 脛骨平臺骨折術后輔助CPM能早期提升膝關節屈曲角度，但并不能提高遠期的膝關節活動度和最終的膝關節功能。【Abstract】 Objective To compare the therapeutic effect of continuous passive motion (CPM) treatment after tibial plateau fractures operation. Methods From June 2008 to June 2009, 86 patients were treated due to closed tibial plateau fractures without combined injuries. The patients were treated with (27 patients, CPM group) and without (59 patients, control group) CPM. The wound healing rates, range of motion and the knee function were compared between the two groups. Results There was no significant difference between the two groups in wound healing rates (P=0.566). Two and six weeks after the operation, there were significant differences between the two groups in flexion degree (Plt;0.001); three and 12 months after the operation, there were no significant differences between the two groups (P=0.219, P=0.512). At the 2nd and 6th week, 3rd and 12th month postoperatively, there were no significant differences between the groups in extension degree. Twelve months after the operation, there were no significant differences between the groups in functional recovery of the knee. Conclusion CPM in the post-operative treatment of tibial plateau fractures is effective increasing knee flexion in the early stage, but is not effective increasing range of motion or knee function in a long term.
【Abstract】 Objective To evaluate the effectiveness of percutaneous fixation with il iosacral screw in the management of unstable pelvic fractures. Methods From March 2003 to January 2007, 15 patients with unstable pelvic fractures were treated by percutaneous fixation with il iosacral screws. There were 6 males and 9 females, aged 21-56 years. Fractures were caused by traffic accident in 8 cases, high fall ing in 6 cases and crushing injury in 1 case. The disease course ranged from 4 hours to 3 days. Of 15 patients, 7 had fractures of pubium and sacrum; 2 had fractures of il ium and sacrum; 4 had dislocation of sacroil iac joint with fractures of pubic rami; and 2 had dislocation sacroil iac joint with fracture of sacrum of pubium. Anterior fixation was performed by means of plating in 3 cases, by external fixation in 7 cases, and by both in 5 cases. Results The blood loss was from 1 000 to 1 500 mL in 4 patients with acetabular fracture and about 50 mL in the others. The average operative time was 153.6 minutes (range, 60-305 minutes). Fifteen patients were followed up 6 months to 3 years with an average of 18months. According to Matta criterion for fracture reduction, the results were excellent in 14 cases and good in 1 case. After a follow-up of 28.8 months, fracture union was achieved in all patients. Screw loosening occurred in 1 case, pain of lumbosacral region in 3 cases after tiredness and mild claudication in 2 cases. Nine patients returned to their occupation, three patients changed occupation, and 3 patients could not work at last follow-up. According to Majeed functional scoring, the results were excellent in 11 cases and good in 4 cases. Conclusion Percutaneous il iosacral screw fixation is a useful method in treatment of unstable pelvic fracture.
Objective To compare the effects of arthroplasty with that of intenal fixation for displaced femoral neck fractures in the elderly. Methods We searched for all randomized controlled trials and quasi-randomized controlled trials of hip arthroplasty versus internal fixation for displaced femoral neck fractures in the elderly by electronically searching MEDLINE( 1966 to September, 2006),EMbase(1966 to September, 2006), Cochrane Library( Issue 4 2006), CBM( up to September, 2006) and CNKI (September, 2006) and handsearching grey literatures. The quality of the trials was assessed and meta-analyses were conducted using The Cochrane Collaboration’s RevMan 4.2.8 software. The quality of the trials was assessed. And meta-analysis was conducted by using RevMan4.2.8 software. Results A total of 228 papers were retrieved, but only 15 published randomized controlled trials involving a total of 2 254 patients were suitable for inclusion in the review. Based on the meta-analyses, hip arthroplasty showed obvious advantages over internal fixation in terms of the incidences of major complications after 2 years (RR 0.15 ; 95%CI 0.09 to 0.23) and after 5 years (RR 0.18 ; 95%CI 0.11 to 0.30) as well as re-operation rate (RR0.12 ; 95%CI 0.08 to 0.18) after 2 years, and after 5 years (RR0.11 ; 95%CI 0.06 to 0.22), there was an advantage to performing hip asthroplasty. After one year, the mortality was the same in both groups with RR 1.05 and 95%CI 0.89 to 1.23. Conclusion There is an evidence base to support arthroplasty as a treatment for displaced femoral neck fractures in the elderly. Arthroplasty can not only decrease the rate of re-operation, but can also reduce the incidence of complications, with similar one-year mortality when compared to internal fixation.